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FMPR and INDE > INDE > Flashcards

INDE Flashcards

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1
Q

Why is melena black?

A

The iron in blood is oxidized as it passes through the bowels. Melena generally signifies an upper GI bleed whereas hematachezia generally signifies a lower GI bleed. According to wiipedia it takes ~14 hours for the oxidation.

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2
Q

What is the difference between tendons and ligaments?

A

Ligaments attach bone to bone Tendons attach muscle to bone

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3
Q

What is a bursa?

A

A flat pouch of synovial fluid that usually cushions joint movement, but can become inflammed and cause pain

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4
Q

What is the main bursa to be aware of in the shoulder?

A

The subacromial bursa

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5
Q

What are the three main shoulder problems?

A

Pain Instablity Decreased range of motion (remember: referred pain possible…)

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6
Q

Important associated MSK symptoms

A

clicking (crepitus), stiffness, weakness, swelling

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7
Q

What’s the general flow of MSK exams?

A

Look Feel Move (flex, extend, abduct, adduct, internal and external rotation) Special Tests Neurovascular

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8
Q

What structures are you feeling for in the shoulder?

A

Bony: clavicle, acromion, spine of scapula, medial border of scapula Muscles: teres minor, infraspinatus, supraspinatus, deltoids

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9
Q

What is shoulder impingement? What movements are painful?

A

compression of soft tissues between the acromion and the greater tuberosity of the humeral head. Elevation +/- internal rotation Pain when reaching overhead or behind the back Stiffness in the morning

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10
Q

What are the special tests for shoulder impingement?

A

Painful arc (abduct arms, most painful between 70 and 120 degrees) Drop arm test ( examiner abducts arm up to shoulder level, then tells pt to smoothly lower arm. pain or ratcheting are positive) Hawkins Sign Neer’s sign

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11
Q

What is the sulcus sign?

A

grab around the acromial clavicular joint, pull the arm down. a sulcus around the glenohumeral joint is indicative of joint laxity/instability

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12
Q

Differentiate between features of OA and rotator cuff tear in the shoulder

A

OA: uncommon in shoulder, deep ache and stiffness, develops over years, bone-on-bone feeling limits ROM Rotator cuff tear: preceded by trauma or repetitive movement, painful with specific movements, can have associated impingement, pain/weakness limits ROM

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13
Q

Common elbow complaints

A

fractures/dislocations medial and lateral epicondylitis (tennis and golfers elbow) Olecranon bursitis Inflammatory arthritis Instability Ulnar nerve injury

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14
Q

What is the common flexor and extensor origin of the elbow (wrist?)?

A

Flexor: medial epicondyle Extensor: lateral epicondyle

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15
Q

What are the common names for medial and lateral epicondylitis?

A

Medial: golfer’s elbow Lateral: tennis elbow

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16
Q

What are the active and passive provocation tests for lateral and medial epicondylitis?

A

Passively extend/flex the wrist and fingers (passive provocation) Have patient resist your attempt to flex or extend (active provocation)

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17
Q

What are healthy and unhealthy stool colors for neonates?

A
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18
Q

What is Broselow tape?

A

A pediatric tape measure with quick reference values on it (e.g. BP, HR, med dosages)

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19
Q

Can pyloric stenosis be palpated?

A

Yes- olive shaped. May also see a visible peristaltic wave after eating

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20
Q

What will the DRE elicit in a child with acute appendicitis?

A

tenderness anteriorly and to the right

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21
Q

What is VACTERL and what is the clinical significance?

A

AKA VATER syndrome: a group of congenital anomalies that tend to occur together. The finding of one of these should prompt the clinician to evaluate the patient for the rest.

Vertebral

Anal atresia

Cardiac defects

Tracheo-

Esophageal

Renal

Limb

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22
Q

What is gastrochisis? What is omphalocele?

A

Both are congenital anomalies where the bowel protrudes through the anterior abdominal wall. They have different pathogenesis. Omphalocele has clear membrane around it and may contain liver

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23
Q

What is the CAGE screen?

A

Have you ever felt you need to cut back

Has anyone annoyed you by criticizing your drinking

Have you ever felt guilty about drinking

Have you ever had to drink first thing in the morning to get rid of a hangover or steady your nerves (eye-opener)?

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24
Q

GI history alarm symptoms

A

nocturnal symptoms

involuntary weight loss

intereference with daily functioning

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25
What are the two phases of swallowing? Are they voluntary or involuntary? What is the difference between dysphagia and odynophagia?
1. Transfer/oropharyngeal: voluntary 2. Esophageal: involuntary Dysphagia: difficulty swallowing Odynophagia: pain swallowing (e.g. due to esophagitis)...feels like a razor blade
26
Dysphagia with regurgitation, choking and coughing would be suggestive of dysfunction in which phase of swallowing?
The oropharyngeal phase
27
Dysphagia with solids but not liquids is suggestive of what? What are possible causes?
Something structural as opposed to a mobility issue. * esophageal ring (concentric..e.g. Schatzki ring) or web (eccentric) * esophageal stricture * esophageal cancer * mediastinal compression (e.g. enlarged hilar node, goiter)
28
differentiate poor appetite and early satiety
- don't feel like eating vs. getting full early
29
nausea and vomiting that improves when fasting suggests what kind of etiology
something GI related
30
How to assess for volume depletion?
* urine output * mentation * postural Sx * cap refill * skin tugor * JVP * peripheral pulses
31
Hematemesis or coffee ground emesis suggests bleeding from which anatomic part of the GI tract? What is the differential?
Proximal to the ligament of Trietz:
32
What can turn stool black?
* iron * peptobismol * blood
33
Differentiate visceral and parietal pain
Visceral * the visceral peritoneum is poorly innervated so pain is vague, often localized to midline, restless pain with variable quality (ache, burn, cramp) Parietal * the parietal peritoneum is well innervated. The pain is consistent and severe, exacerabted by movement so pt is v. still
34
What color is bilious vomit?
green OR bright yellow "beware of the child who vomits green"
35
Define obstipation
Obstipation: failure to pass gas or stool vs. constipation is less than 3 BM/day--\>week
36
Diarrhea that is completely improved with fasting suggests what kind of underlying cause? Small volume diarrhea is more likely _____ whereas large volume diarrhea is more likely\_\_\_\_
osmotic small volume = colonic large volume = small bowel
37
What the particle size limit between droplet and airborne precautions? What are examples of pathogens that fit into each category (including contact)?
Droplet: \>5 um (diptheria, pertussis, influenza Airborne: \<5 um (these droplets can be suspended in the air for a long time...TB, SARS, chickenpox) Contact: MRSA, C. diff
38
What percentage of adults carry C. diff? What general steps to take with suspected C. diff associated disease?
\<2% Initiate contact precautions. Test for C. diff. Review antibiotics and discontinue unless clearly indicated. Commence PO vancomycin +/- metronidazole
39
What to exposure risks to ask about with diarrhea?
* water supply * travel/camping/cruises * contacts sick? * food sources, refrigeration * animal contact * swimming pools? * daycare * hospitals/nursing homes..
40
Qualitative vs. quantitative fit testing
Qualitative: ability to smell/taste substances Quantitative: measure penetration of particles
41
What are the fours stages of clubbing?
1. Increased flutuance of nail bed 2. Loss of angle between nail and nail bed (Shamroth's sign) 3. increased curvaure longitudinally and transversally 4. Drumstick appearance
42
What might the following indicates: * enlarged beefy tongue * angular stomatitis
- B12 or folate deficiency iron deficiency anemia
43
If patient has tense abdomen during exam, how to overcome this?
Flex the legs
44
Castell's sign vs. Traube's space
Traube's space you expect to be resonant all the time Castell's sign is positive if you hear dullness on inspiration
45
How to differentiate and enlarged left kidney and the spleen?
The spleen has notches and, cannot palpate the upper border and moves inferomedially on inspiration The kidney has no notches, the upper border cannot be palpated and moves inferiorly on inspiration
46
When would you see rebound tenderness?
with peritonitis, most commonly appendicitis
47
What are the obturator and psoas signs?
48
What history points would differentiate dysphagia from the following causes: * GERD * Schatzki ring * EoE * CA * motility dysfunction
49
Why ascultate the liver? Why auscultate the spleen?
You could hear a bruit (e.g cancer) or a rub ( e.g. perihepatitis in Fitz-Hugh-Curtis syndrome). May hear a splenic rub i fyou have a splenic infarct
50
What is the difference between irreducible and incarcerated hernia?
Irreducible means that it can't be manually reduced, incarcerated means it has been strangulated (circulation cut off). Need to listen for bowel sounds to help determine whether incarcerated and to r/o bowel obstruction from hernia.
51
What is a Blumer's shelf?
A finding on DRE- metastasis to the pouch of douglas
52
Cullen sign
blue coloration around umbilicus from retroperitoneal bleeding Grey Turner sign ecchymoses on flanks from massive retroperitoneal bleeding
53
What are differences between direct and indirect hernias based on what happens when the patient stands and lies down?
Indirect: takes a while to reach it's full size when standing, doesn't reduce immediately upon laying down. more likely to strangulate. Direct: opposite
54
What are the geriatric giants (x10)?
* Vision and hearing * Malnutrition * Falls * Urinary incontinence * Bowel function * Depression * Chronic pain * Memory loss * Iatrogenesis * drug and alcohol abuse
55
What are ADLs and iADLs
ADL: dressing, eating, toileting, ambulating, transferring, bathing, personal hygiene iADL: shopping, cleaning, medication management, food prep, transportation
56
What are frontal release signs?
Frontal release signs are primitive reflexes traditionally held to be a sign of disorders that affect the frontal lobes. The appearance of such signs reflects the area of brain dysfunction rather than a specific disorder which may be diffuse such as a dementia, or localised such as a tumor. (WIkipedia)
57
Differentiate shoulder impingement and OA pain
Shoulder impingement: shoulder elevation +/- internal rotation (pain reaching overhead, behind the back OA: uncommon, deep ache, diminished ROM (abduction and EXternal rotation)
58
Normal carrying angle of elbow
valgus
59
What are the phases of gait?
Stance (heel---\> flat foot--\> push off) and swing
60
Genu recurvatum can be associated with what?
quadricepts weakening
61
What is a Lisfranc fracture?
4th tarsal-metatarsal fracture
62
What would give you hallux rigidus?
bone spurs or degenerative changes at the 1s MTP joint
63
differentiate trigger finger and dupuytren's
Trigger: the tendon is swollen and doesnt slide through the sheath Dupuytren;s: the palmar aponeurosis
64
What nerve damage would decrease ability to oppose?
median...probably ulnar too, but median is in the notes
65
What is de quervain's tenosynovitis?
irritated tenosynovium of extensor pollicis brevis, abductor pollicis longus (1st extensor compartment)
66
What is a sufficient view for C-spine xray?
C1- C7/T1 junction
67
What is normal mouth opening width?
At least three finger breadths
68
What spinal level is the spine of the scapula?
T4
69
What are the Jendrassik maneouvres?
Running interference on the brain...for upper limb have them clench teeth, for lower limb have them clasp hands in front of sternum and pull
70
What is the main focusing power of the eye?
The corner (35-35 diopters) The lens adds (20 diopters)
71
Which eye do you use first for: * visual acuity * pupillary exam (direct, consensual, near, swinging flashlight) * eye movements * visual field testing (confrontational) * opthalmoscopy
* visual acuity: right eye * pupillary exam: right eye * eye movements (no glasses) (start the H by moving from the centre to the left * confrontational testing: start with the left eye * opthalmoscopy: right eye
72
Define bipolar hemianopia and homonymous hemianopia
Bipolar hemanopia: loss of half of the field of vision in each eye (e.g. both lose temporal) Homonymous hemianopia: loss of the same half of visual field (e.g. right temporal, left nasal)
73
What do you exam with an opthalmoscope and what do you examine with a slit-lamp?
Slit-lamp: conjunctiva, cornea, anterior chamber, iris, lens Opthalmoscope: optic nerve, macula, retina
74
What kind of correction do you use on the opthalmoscope for myopes and hyperopes?
Myopes: negative Hyperopes: positive
75
What is the mean intraocular pressure?
16 mmHg +/- 2.5
76
What is presbyopia?
Diminished accomodation due to aging
77
What is 20/20 vs. 20/50 vision?
tested/normal eye...so for 20/50 the tested eye can see at 20ft what the normal eye can see at 50 ft
78
What is a contraindication to pupillary dilation?
Narrow iridocroneal angle--\> can get angle closure glaucoma
79
What are the 4 common causes of loss of vision in the elderly? What are the classic symptoms of each?
macular degenation: central scotoma (hole in central field of vision) Diabetic retinopathy: floaters Cataracts: monocular diplopia Glaucoma
80
What are the components of the MMSE? When can't it be used?
\*\*not useful in delirum Orientation: time and place Registration: remember 3 words Attention: spell WORLD forward and backwards Recall: 3 words given earlier Language and praxis: naming objects, repetition of sentence, 3 stage command, read and follow instruction Visual construction: copy diagram

FMPR and INDE (5 decks)

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